Road Map Toward Computer-Guided Total Synthesis of Natural Products. The Dysiherbol A Case Study: What if Serendipity Hadn't Intervened?

We present a computational study inspired by the story of dysiherbol A, a natural product whose putative structure was found incorrect through synthesis by a completely fortuitous event. While the carbon connectivity and chemical environment between both structures remain similar, the real dysiherbol A has a different molecular weight than that reported for the natural product. Had the synthesis groups not been favored by fortune, it could be speculated that a substantial amount of time and effort would have been required to solve the structural puzzle. Within the realm of computer-guided total synthesis of natural products, the question arose whether a synthesis group could have in silico reassigned the structure before embarking on the experimental adventure. To address this query, we evaluated some state-of-the-art computational procedures based on their computational demand and ease of implementation for nonexpert users with basic skills in computational chemistry (including HOSE, CASCADE, ANN-PRA, ML-J-DP4, DP4, and DP4+). While discussing the strengths and limitations of these methods, this case study provides a roadmap of what could be done before venturing into complex and time-demanding total synthesis projects.

E/Z configurational determination of oximes and related derivatives through quantum mechanics NMR calculations: scope and limitations of the leading probabilistic methods.

Oximes and related derivatives featuring a CN double bond are important in many areas of chemistry. Different methods for the determination of the E/Z configuration have been developed, each with its own scope and limitations. While some cannot be used when only one isomer is available, others require special NMR experiments. Here, three popular computational methodologies (DP4, DP4+, and ML-J-DP4) have been thoroughly studied using a challenging test set. Although DP4+ provides the best confidence, its computational cost might be high. On the other hand, ML-J-DP4 shows excellent performance in most cases in a fraction of CPU time. A detailed analysis of the structural factors affecting the NMR prediction and sense of the assignment is also provided.

Protective Effect of Neutral Electrolyzed Saline on Gentamicin-Induced Nephrotoxicity: Evaluation of Histopathologic Parameters in a Murine Model.

Background and Objectives: Gentamicin (GM) is a nephrotoxic aminoglycoside. Neutral electrolyzed saline (SES) is a compound with anti-inflammatory, antioxidant, and immunomodulatory properties. The objective of the present study was to evaluate whether kidney damage by GM can be prevented and/or reversed through the administration of SES. Materials and Methods: The study was carried out as a prospective, single-blind, five-arm, parallel-group, randomized, preclinical trial. The nephrotoxicity model was established in male BALB/c mice by administering GM at a dose of 100 mg/kg/day intraperitoneally for 30 days, concomitantly administering (+) SES or placebo (physiologic saline solution), and then administering SES for another 30 days after the initial 30 days of GM plus SES or placebo. At the end of the test, the mice were euthanized, and renal tissues were evaluated histopathologically. Results: The GM + placebo group showed significant tubular injury, interstitial fibrosis, and increased interstitial infiltrate of inflammatory cells compared with the group without GM. Tubular injury and interstitial fibrosis were lower in the groups that received concomitant GM + SES compared with the GM + placebo group. SES administration for 30 days after the GM administration periods (GM + placebo and GM + SES for 30 days) did not reduce nephrotoxicity. Conclusions: Intraperitoneal administration of SES prevents gentamicin-induced histologic nephrotoxicity when administered concomitantly, but it cannot reverse the damage when administered later.

COVID-19 and child welfare policy in Chile: The experience of front-line workers.

COVID-19 arrived in Chile amid social protests that questioned the State's ability to protect children's rights. Nevertheless, child policy workers continued working despite the drastic changes to their daily work generated by both the pandemic and conflicts within the child welfare system. In this article, we aim to understand how these workers have experienced and overcome these challenges. We show that they have continued doing interventions with children at the expense of their economic resources and well-being. Our findings highlight the need for the government to take immediate action, offering guidelines to improve child policy workers' labor conditions.

Obesity and the obesity paradox in patients with severe COVID-19.

OBJECTIVE: To test the presence of the obesity paradox in two cohorts of patients hospitalized for COVID-19. DESIGN: Two multicenter prospective cohorts. SETTING: Three fourth level institutions. PATIENTS: Adults hospitalized in the general ward for confirmed COVID-19 in the three institutions and those admitted to one of the 9 critical care units of one of the institutions. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Categorized weight and its relationship with admission to the ICU in hospitalized patients and death in the ICU. RESULT: Of 402 hospitalized patients, 30.1% were obese. Of these, 36.1% were admitted to the ICU vs. 27.1% of non-obese patients. Of the 302 ICU patients, 46.4% were obese. Of these, mortality was 45.0% vs. 52.5% for non-obese. The requirement to transfer hospitalized patients to the ICU admission get a HR of 1.47 (95%CI 0.87-2.51, p = 0.154) in the multivariate analysis. In intensive care patients, an HR of 0.99 (95%CI: 0.92-1.07, p = 0.806) was obtained to the association of obesity with mortality. CONCLUSIONS: The present study does not demonstrate an association between obesity and risk of inpatient transfer to intensive care or death of intensive care patients due to COVID-19 therefore, the presence of an obesity paradox is not confirmed.

Influence of the CH/B replacement on the Reactivity of Boranthrene and Related Compounds.

The influence of the replacement of CH groups by boron atoms on the reactivity of planar polycyclic aromatic hydrocarbons has been explored by means of computational tools. To this end, [4 + 2]-cycloaddition reactions involving anthracene and neutral boranthrene with different dienophiles such as ethylene, acetylene, and CO2 have been compared. In addition, the influence of additional fused aromatic rings (pentacene or borapentacene) on the reactivity of these species has been also explored. It was found that the B-doped systems are systematically much more reactive than their all-carbon counterparts from both kinetic and thermodynamic points of view. The observed trends in reactivity are quantitatively analyzed in detail using state-of-the-art methods, namely, the activation strain model of reactivity and the energy decomposition analysis method. Our calculations reveal the importance of molecular orbital interactions as the key factor responsible for the enhanced reactivity of the B-doped systems.

[Trends of thyroid pathology in a referral center: steady prevalence of papillary thyroid carcinoma but goiter increase in thyroidectomies]. / Tendencias en patología tiroidea en un centro de referencia: prevalencia estable del carcinoma papilar e incremento de hiperplasia nodular en tiroidectomías.

INTRODUCTION: Changes in the prevalence of papillary thyroid carcinoma (PTC) have been reported in institutions and national cancer registries. OBJECTIVE: To describe time trends in benign and malignant thyroid diseases in a national endocrine referral center. MATERIALS AND METHODS: Systematic review and classification of consecutive specimens with slides/paraffin blocks in surgical pathology archives (January 1990 to December 2009). Institutional registries, size, type of surgery and number of inclusion blocks were recorded. Patients whose registries were granted before January 1990 without nodules, but treated after twelve months for a suspicious thyroid lesion, were included. These patients in a passive follow-up permitted incidence density calculations. Cases were grouped by quinquennium. RESULTS: Institutional registers were conceded to 103,961 persons worthy of attention, and 1,269 were submitted to thyroidectomies (1.2%). One hundred twenty four patients none treated for thyroid diseases before 1990, developed thyroid nodules after 1991. The incidence density for goiter was 0.05 person/year and for PTC 0.04 person/year in that group. In all series woman to man relation was 9:1 with a mean age of 45 years. Total or near total thyroidectomies were performed in 60% patients and benign diseases were diagnosed in 732 (52%) cases. Thyroid surgeries increased since 2005 (p=0.03) with a rise in goiter prevalence (0.25, 0.31, 0.35, 0.38, p for trend 0.0005), without significant increase in PTC prevalence (0.41, 0.43, 0.35, 0.40, p for trend 0.71) in thyroidectomies. CONCLUSIONS: Goiter as the only finding in thyroid specimens increased 52% in the last 20 years. PTC prevalence is steady with a higher number of tumors<3 cm.

Rationalizing the influence of α-cationic phospholes on π-catalysis.

The physical factors behind the experimentally observed high activity of gold(I)-catalysts having an α-cationic phosphole as a ligand have been computationally explored. To this end, the gold(I)-catalysed hydroarylation reactions of phenylacetylene and mesitylene involving both neutral and cationic phosphole as well as phosphine ligands have been quantitatively analyzed in detail with the help of the activation strain model of reactivity in combination with the energy decomposition analysis method. It is found that the cationic phosphole ligands induce a dramatic change in both the geometry and the electronic structure of the initially formed π-complex which significantly enhances its electrophilicity. This results in an enhancement of the key π(mesitylene) → π*(LAu-acetylene complex) molecular orbital interaction which is the main factor responsible for the activating effect of these cationic ligands.

Eco-friendly methoximation of aromatic aldehydes and ketones using MnCl2.4H2O as an easily accessible and efficient catalyst.

Methoximes are important as a class of intermediates and products, among fine chemicals and specialties. The development of a new, facile and efficient method for their synthesis is reported. The methoximes were properly accessed from the corresponding aromatic aldehydes and ketones in good to excellent yields, under mild conditions, employing the inexpensive and environmentally friendly MnCl2.4H2O as a catalyst (at low loading and without the addition of ligand), in EtOH at 50°C. The scope of the process was systematically assessed.

First total synthesis of chromanone A, preparation of related compounds and evaluation of their antifungal activity against Candida albicans, a biofilm forming agent.

A straightforward and convenient approach for the first total syntheses of chromanone A and a related 7-OMe substituted natural product is reported. These unique C-3 substituted 2-hydroxymethyl chromones were recently isolated as fungal metabolites. Chromanone A was synthesized in 25.3% overall yield from the readily available pyrocatechol, whereas the second natural product was prepared in 39.7% global yield. A small library of chromones, including both natural products and some of their synthetic heterocyclic precursors, was evaluated against Candida albicans ATCC 10231, a biofilm forming agent. It was found that 8-methoxy-3-methyl-4-oxo-4H-chromene-2-carbaldehyde, a partially oxidized form of chromanone A, exhibited a minimum inhibitory concentration of 7.8 µg mL-1 and significantly inhibited the yeast's virulence factors, including the adherence to buccal epithelial cells and the secretion of phospholipases, as well as the formation of germ tubes and the generation of the hyphal pseudomycelium. In addition, despite the heterocycle exhibiting non-significant inhibition of the formation of the Candida biofilm, it completely inhibited the growth of C. albicans in preformed biofilms at 62.5 µg mL-1.

Improve cognitive impairment using mefenamic acid non-steroidal anti-inflammatory therapy: additional beneficial effect found in a controlled clinical trial for prostate cancer therapy.

Inflammation is an essential component of prostate cancer (PCa), and mefenamic acid has been reported to decrease its biochemical progression. The current standard therapy for PCa is androgen deprivation therapy (ADT), which has side effects such as cognitive dysfunction, risk of Alzheimer's disease, and dementia. Published results of in vitro tests and animal models studies have shown that mefenamic acid could be used as a neuroprotector. Objective: Examine the therapeutic potential of mefenamic acid in cognitive impairment used in a controlled clinical trial. Clinical trial phase II was conducted on patients undergoing ADT for PCa. Two groups of 14 patients were included. One was treated with a placebo, while the other received mefenamic acid 500 mg PO every 12hrs for six months. The outcome was evaluated through the Mini-Mental State Examination (MMSE) score at six months. At the beginning of the study, both groups had similar MMSE scores (mefenamic acid vs. placebo: 26.0±2.5 vs. 27.0±2.6, P=0.282). The mefenamic acid group improved its MMSE score after six months compared with the placebo group (27.7±1.8 vs. 25.5±4.2, P=0.037). Treatment with mefenamic acid significantly increases the probability of maintained or raised cognitive function compared to placebo (92% vs. 42.9%, RR=2.2, 95% CI: 1.16-4.03, NNT=2.0, 95% CI: 1.26-4.81, P=0.014). Furthermore, 42.9% of the placebo group patients had relevant cognitive decline (a 2-point decrease in the MMSE score), while in patients treated with mefenamic acid, cognitive impairment was not present. This study is the first conducted on humans that suggests that mefenamic acid protects against cognitive decline.

Furo[3,2-c]coumarins carrying carbon substituents at C-2 and/or C-3. Isolation, biological activity, synthesis and reaction mechanisms.

The isolation, biological activity and synthesis of natural furo[3,2-c]coumarins are presented, covering mainly the developments in the last 35 years. The most relevant approaches toward the synthesis of 2-substituted, 3-substituted and 2,3-disubstituted heterocycles are also discussed, with emphasis on the efficiency of the processes and their mechanisms.

Synthesis and evaluation of aromatic methoxime derivatives against five postharvest phytopathogenic fungi of fruits. Main structure-activity relationships.

The antifungal activity of a library of twenty-four aromatic methoximes was examined against five representative postharvest phytopathogenic fungi. The panel included Penicillium digitatum, Penicillium italicum, Rhizopus stolonifer, Botrytis cinerea and Monilinia fructicola, all of which cause relevant economic losses worldwide as a result of affecting harvested fruits. The minimum inhibitory concentrations and minimum fungicidal concentrations of each compound were defined and the main structure-activity relationships were determined. Although other congeners were more potent, drug likeliness considerations pointed to the methoxime derived from 2,4-dihydroxypropiophenone as the compound with the most suitable profile. The morphology of the colonies of the fungal strains treated with the methoxime was examined microscopically and the compound was also tested in freshly harvested peaches and oranges, exhibiting promising control profiles in both fruits, similar to those of the commercial agents Imazalil and Carbendazim.

Forty-Year-Old Man With Abdominal Pain 4 Years Post-Renal Transplant: A Case Report.

Tuberculosis (TB) is an opportunistic infection 20 to 74 times more frequent in immunocompromised patients compared to the general population. The prevalence with renal transplant had a 0.5% to 15% incidence. The infection could be pulmonary or extrapulmonary (EPTB). The EPTB accounts for almost 20% of TB cases in immunocompetent people and 50% in positive human immunodeficiency virus cases. In this case report, we present a patient who attended the emergency room because of chronic diarrhea, abdominal pain, loss of weight, nocturne diaphoresis, and intermittent fever. A computed tomography scan showed retroperitoneal ganglionic conglomeration. He got into an exploratory laparotomy for histopathology specimens and paraganglionic fluid culture to a Gene Xpert MTB-RIF Assay G4, positive for rifampicin resistance tuberculosis. After an individualized treatment, trying to protect the graft's remaining function, the patient returned with acute abdominal pain and pancreatic enzymes elevation; the antibiotic management had to be suspended until the return of renal function.

A convenient and eco-friendly cerium(III) chloride-catalysed synthesis of methoxime derivatives of aromatic aldehydes and ketones.

The use of CeCl3·7H2O as an efficient and eco-friendly promoter for the convenient synthesis of methoximes derived from aromatic aldehydes and ketones, is reported. The transformations entail the use of equimolar amounts of MeONH2·HCl and NaOAc in EtOH at 50°C, and no special precautions are needed with regard to the presence of oxygen. The scope and limitations of the transformation were studied and a reaction mechanism was proposed.

Huellas afectivas del trabajo en política de protección a la infancia / Affectivity in the implementation of child welfare policies / Traços afetivos do trabalho de política de proteção à infância

Resumen (analítico) Chile es un caso emblemático en la instalación de una política de protección a la infancia con orientación neoliberal. Actualmente, esta política es ejecutada casi completamente por organizaciones privadas, financiadas conforme al logro de indicadores de desempeño estandarizados. Algunas investigaciones plantean que estos indica-dores gobiernan la racionalidad de los trabajadores y trabajadoras; empero, estudios internacionales señalan que este tipo de gobernanza no solo es racional, sino también afectiva. A partir de un análisis textuala-fectivo de 14 entrevistas individuales y dos talleres grupales realizados a cinco trabajadoras y un trabajador de distintos organismos colaboradores del Servicio Nacional de Menores, se reporta que este modelo de gestión consume y maquiniza los cuerpos de estas y estos profesionales. No obstante, el afecto es el que hace posible la resistencia.

Abstract (analytical) Chile is an emblematic case in the implementation of a neoliberal child welfare policy. This policy is now almost entirely undertaken by private organizations, financed based on their achievement of standardized performance indicators. Scientific literature suggests that these indicators govern workers' rationality. However, international studies indicate that the effect of indicators is not just rational but also affective. From a textual-affective analysis of 14 interviews and 2 workshops conducted with 5 female workers and 1 male worker from different partner organizations within the Chilean National Service for Minors, participants reported that this management model consumes and mechanizes the work carried out by these professionals. However, it is affectivity that makes resistance possible.

Resumo (analítico) O Chile é um caso emblemático na instalação de uma política neoliberal de proteção à criança. Esta, é hoje quase inteiramente executado por organizações privadas, financiadas de acordo com a obtenção de indicadores de desempenho padronizados. Pesquisas sugerem que estes indicadores governam a racionalidade dos trabalhadores; enquanto estudos internacionais indicam que este governo não é apenas racional, mas também afetivo. A partir de uma análise textual-afetiva de 14 entrevistas e duas oficinas realizadas a cinco trabalhadoras e um trabalhador de diferentes Organizações Colaboradoras do Serviço Nacional de Menores, é relatado que este modelo de gestão consome e mecaniza os órgãos destes profissionais. No entanto, é o afeto que torna possível a resistência.

Early warning scores to identify the risk of clinical worsening or death in patients hospitalized for COVID-19

Background: identifying patients at risk for negative outcomes is key for performing a timely triage and adapting the care intensity for patients with COVID-19. Early warning scores are rules that alert to the risk of adverse outcomes during hospitalization. We sought to validate the modified NEWS, NEWS-2 and COVID-19 Severity Index (CSI). Methods: a prospective observational multicenter study of patients hospitalized for CO VID-19 at three quaternary care hospitals in Bogotá, Colombia, between April and November 2020. The operating characteristics and areas under the ROC curve were calculated. Results: 711 patients were included, in whom the AUC for death was 0.68, 0.58 and 0.68, and for ICU admission was 0.61, 0.63 and 0.66 for mNEWS, NEWS-2 and CSI, respectively. The CSI had the greatest sensitivity for ICU admission or death (87.6 and 90.0%) and NEWS-2 had the greatest specificity (76.8 and 75.5%). Conclusions: the three early warning scores had a low to moderate performance in pre dicting ICU admission or death in patients hospitalized for COVID-19. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2225).

Antecedentes: la identificación de los pacientes con riesgo de desenlaces negativos es clave para realizar un triage oportuno y adecuar la intensidad de los cuidados en los pacientes con COVID-19. Las puntuaciones de alerta temprana son reglas para advertir el riesgo de desenlaces adversos durante la hospitalización. Buscamos validar el NEWS modificado, NEWS-2 y COVID-19 Severity Index. Metodología: estudio observacional, prospectivo, multicéntrico con pacientes hospitalizados por COVID-19 en tres hospitales de cuarto nivel en Bogotá (Colombia), entre abril y noviembre de 2020. Se calcularon las características operativas y áreas bajo la curva ROC. Resultados: se contó con 711 pacientes entre los cuales el AUC para muerte fue 0.68, 0.58 y 0.68, y para ingreso a UCI de 0.61, 0.63 y 0.66 para NEWSm, NEWS-2 y CSI respectivamente. El CSI alcanzó la mayor sensibilidad para ingreso a UCI o muerte (87.6 y 90.0%) y la mayor especificidad fue el NEWS-2 (76.8 y 75.5%). Conclusiones: las tres puntuaciones de alerta temprana mostraron un desempeño bajo a moderado para la predicción del ingreso a UCI o muerte en pacientes hospitalizados por COVID-19. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2225).

Variables demográficas, clínicas y anatomopatológicas en fallecidos del servicio de Nefrología del Hospital "Dr. Luis Díaz Soto" entre 1974-2013 / Demographic, Clinical and Anatomical and Pathological Variables in Deaths of the Nephrology Department of Dr. Luis Díaz Soto Hospital (1974-2013)

Introducción: las enfermedades renales constituyen una causa frecuente de consulta médica, de ingreso hospitalario y de mortalidad. Objetivo: analizar algunas variables demográficas, clínicas y anatomopatológicas en fallecidos por estas enfermedades durante 40 años en un servicio de Nefrología. Métodos: estudio retrospectivo y observacional de variables demográficas, clínicas y anatomopatológicas en 272 fallecidos del servicio de nefrología del hospital Dr. Luis Díaz Soto, a los que se les practicó autopsia, ocurridas de 1974 al 2013. Resultados: predominaron los pacientes masculinos, de piel blanca y con edades de 35 a 64 años. La edad promedio se ha ido incrementando. Los principales diagnósticos clínicos de causa directa de muerte fueron bronconeumonía, infarto agudo de miocardio y shock. Como causa básica se plantearon la insuficiencia renal crónica, la hipertensión arterial y la diabetes mellitus. En los estudios anatomopatológicos fueron señaladas como más frecuentes causas directas de la muerte la bronconeumonía, el edema pulmonar, el shock y el infarto agudo de miocardio; mientras que en los principales diagnósticos de causa básica de muerte fueron registrados el riñón terminal, la cardiopatía hipertensiva, la diabetes mellitus y la aterosclerosis. Conclusiones: los indicadores de mortalidad, necropsia y correspondencia clínico patológica fueron adecuados. Se apreció un incremento, progresivo en el tiempo, de la edad de los pacientes fallecidos estudiados. La bronconeumonía y las cardiopatías fueron las principales causas de muerte. Los signos de aterosclerosis estuvieron presentes en la mayoría de los estudios realizados(AU)

Introduction: Renal diseases are a frequent cause of medical consultation, hospitalization and mortality. Objective: Analyze some demographic, clinical and anatomical and pathological variables in the deaths of renal diseases during 40 years in a Nephrology service. Methods: A retrospective and observational study was conducted of demographic, clinical and anatomical and pathological variables in 272 deaths of the nephrology service at Dr. Luis Díaz Soto hospital, who were autopsied, from 1974 to 2013. Results: There were predominantly male patients, white skin and aged 35 to 64 years. The average age has been increasing. The main clinical diagnoses of direct cause of death were bronchopneumonia, acute myocardial infarction and shock. As a basic cause, chronic renal failure, arterial hypertension and diabetes mellitus were considered. In anatomical and pathological studies, bronchopneumonia, pulmonary edema, shock and acute myocardial infarction were identified as more frequent causes of death; while in the main diagnoses of the basic cause of death, the terminal kidney, hypertensive heart disease, diabetes mellitus, and atherosclerosis were documented. Conclusions: Mortality, necropsy, and clinical pathological correspondence indicators were adequate. There was a progressive increase in the age of the deceased patients studied. Bronchopneumonia and heart disease were the main causes of death. Signs of atherosclerosis were present in most of the studies(AU)

Pleomorphic myofibrosarcoma of the tibia with aneuploid DNA content.

Myofibrosarcomas of the tibia are exceedingly rare, with only one case reported in the literature. We describe DNA ploidy of high-grade myofibrosarcoma of the tibia in correlation with clinicomorphologic and ultrastructural features in a 16-year-old adolescent girl. Radiological studies revealed an expanding osteolytic bone lesion in the metaphysis of proximal tibia. A biopsy was consistent with malignant fibrous histiocytoma. The final diagnosis of myofibrosarcoma was supported by light microscopy and corroborated by electron microscopy and immunohistochemistry findings. The DNA content analysis showed an aneuploid tumor. She developed local recurrence at 6 months after initial treatment with no evidence of lung metastases and 16 months later is alive with persistence of disease. This is the second case reported in the literature with this location. In this case, the high grade correlated with recurrence behavior and aneuploidy DNA content but not with metastases. By ultrastructural analyses, fibronexus and intracellular collagen persisted in high-grade myofibrosarcoma.

Diagnóstico de daño renal crónico terminal en autopsias / Diagnosis of chronic terminal renal damage in necropsis

OBJETIVO: determinar la frecuencia del diagnóstico de daño renal crónico terminal en autopsias de fallecidos de 15 o más años de edad en el Hospital Militar Central Dr. Luis Díaz Soto durante 35 años (1973-2008). MÉTODOS: se aplicó la Clasificación Internacional de Enfermedades, Traumatismos y Causas de Defunción y fue utilizado el Sistema Automatizado de Registro y Control de Anatomía Patológica. El diagnóstico de daño renal crónico terminal se estableció cuando hubo elementos morfológicos de esclerosis renal y diagnóstico clínico de insuficiencia renal crónica. RESULTADOS: se revisaron 12 278 autopsias, en 466 (3,79 por ciento) se diagnosticó daño renal crónico terminal. Correspondieron al sexo masculino el 55,3 por ciento del total de los fallecidos que se les realizó autopsias y el 52,4 por ciento de los que tuvieron daño renal crónico terminal. Se registró un promedio anual de 341 autopsias y 13 diagnósticos de daño renal crónico terminal. La bronconeumonía (23,39 por ciento), el edema pulmonar (13,95 por ciento) y el choque (11,16 por ciento) constituyeron las principales causas directas de muerte. Las causas básicas de muerte más frecuentes fueron esclerosis renal (22,96 por ciento), hipertensión arterial (16,30 por ciento), aterosclerosis coronaria (12,66 por ciento), diabetes mellitus (9,87 por ciento) y aterosclerosis (8,15 por ciento). CONCLUSIONES: el daño renal crónico terminal fue un diagnóstico frecuente en los fallecidos estudiados, su frecuencia se incrementó con la edad y predominó en los del sexo masculino. Las principales causas directas de muerte fueron las complicaciones infecciosas y cardiovasculares; mientras que la aterosclerosis, la hipertensión arterial y la diabetes mellitus resultaron las enfermedades básicas de muerte

OBJECTIVE: to determine the frequency of Terminal chronic renal damage diagnosis in necropsies of deceased persons aged 15 or more in the Dr. Luis Díaz Soto Central Military Hospital over 35 years (1973-2008). METHODS: the International Classification of Diseases, Traumata and death causes was applied and the Automated System of Registry and Control of Pathological Anatomy were used. The diagnosis of terminal chronic renal damage was made when there were morphological elements of renal sclerosis and a clinical diagnosis of chronic renal failure. RESULTS: a total of 12 278 necropsies was reviewed in 466 patients (3.79 percent) a diagnosis of terminal chronic renal damage was made. The 53.3 percent included the male sex of total of deceased underwent necropsies and the 52.4 percent of those with terminal chronic renal damage. There was a yearly average of 341 necropsies and 13 diagnosis of terminal chronic renal damage. The bronchopneumonia (23.39 percent), pulmonary edema (13.95 percent) and chock (11.16 percent) were the leading direct causes of death. The more frequent basic death causes were the renal sclerosis (22.96 percent), high blood pressure (16.30 percent), coronary atherosclerosis (12.66 percent), diabetes mellitus (9.87 percent) and atherosclerosis (8.15 percent). CONCLUSIONS: the terminal chronic renal damage was a frequent diagnosis in study deceased, its frequency increased according to age with predominance of male sex. The leading direct causes of death were the infectious complications and the cardiovascular ones, whereas the atherosclerosis, the high blood pressure and the diabetes mellitus were the basic diseases of death